Biomedical subjects
Publications and source records attributed to J A Wilkinson.
Health and ill-health are subject to wide interpretation between and within lay and professional groups. A simple relationship between health beliefs and behaviour cannot be assumed. Understanding an individual's health locus of control may help to determine the most appropriate health message for that person.
Many patients requiring prostate surgery experience a lack of interest from health-care staff in relation to their views and opinions. Information offered to patients who have undergone prostate surgery is often inadequate as a result of poor communication by health staff. Nurses need to understand the priorities of their patients and use this information to inform the way in which advice is given.
It has been suggested that incomplete digestion of cereal starch explains the low energy values of certain cereals of large particle size. We used human subjects with ileostomies to investigate the digestion of barley and to determine whether the physical form of barley affects stomal excretion of starch, glucooligosaccharides, nitrogen, fat, and calculated energy. Only 2 +/- 1% of starch remained undigested after finely milled barley was eaten, but after flaked barley was eaten 17 +/- 1% resisted digestion, partly as oligosaccharides (G1-G10) but largely as intact unpitted starch granules bound by intact cell walls. The calculated energy excretion from the stoma was three times higher after flaked than after milled barley [51.5 decreasing to 15.3 kJ/g nonstarch polysaccharide (NSP, P < 0.001]. NSP, starch, and fat made almost equal contributions to the higher energy excretion. It is concluded that possibly the botanical source of cereals and certainly processing, other than retrogradation of the starch, are important determinants of starch digestibility and energy value. Possible clinical implications are introduced.
Friedel-Crafts alpha-phenylethylation of benzene and toluene, compared with beta-phenylethylation, shows a low ratio of ortho/para substitution with only 2-3% meta isomer formation, with kT/kB rate ratios between 58 and 76. The data indicate late arenium ion (sigma complex)-like transition states. beta-Phenylethylation in contrast gives low kT/kB rate ratios with a substantially higher ortho/para isomer ratio of 17-21% for the meta substituent. Experimental evidence points to thermodynamically controlled isomerizations effecting results. The data also indicate formation of an oriented pi-complex involving phenyl participation (as contrasted with complete phenonium ion formation) in the alkylation intermediates of the beta-phenylethylation reactions.
The two prime factors in the mechanism of intrauterine displacement of the hip are mesenchymal tissue abnormalities and mechanical stress placed on the fetal hip joint by the leg-folding mechanism. The somatic changes involve general laxity of the articular ligaments, attributable to either the physiologic effects of progesterone or a genetic trait consisting of familial joint laxity. The ligamentous laxity not only interferes with the folding mechanism of the fetal legs but also influences the torsional effect on the hip joints. This facilitates the displacement of the femoral head over the posterior rim of the acetabulum. The mechanical stress caused by the delay in leg folding also appears to play a role in a genetically determined occult form of myelodysplasia. Its prevalence has already been partially revealed by sensory evoked potential tests. Possibly, a more refined motor evoked potential test might help to explain a large percentage of the idiopathic cases. Thus, many of the etiologic factors in congenital hip displacement, previously considered to be caused by pre- and postnatal environmental influences, may well have genetic origins. These origins may be associated with varying degrees of underlying myelodysplasia. The relatively high incidence of firstborn affected, the ratio of female to male patients, the seasonal incidence of birth, and familial and racial prevalence may prove to be genetically predetermined.
We have used a modified technique of cervical osteotomy to treat a consecutive series of 23 patients with chronic slip of the upper femoral epiphysis. It has been successful in correcting both moderate and severe deformities with a low incidence of avascular necrosis, comparable to that seen after subtrochanteric osteotomies. We describe the operative details and discuss the features which make cervical osteotomy technically superior to intertrochanteric and subtrochanteric procedures.
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A case of a patient with an alkaline chemical burn to the face from the misuse of the aerosol form of an oven cleaner is presented. The low concentration of sodium hydroxide and lack of early pain delayed the patient's presentation to the emergency department for two hours. After this delay in seeking treatment, continuous irrigation in the ED did little to modify the pH of the patient's injured skin. Thus, she developed a full-thickness alkaline burn that eventually required skin grafting.
Of a consecutive series of 117 one-year-old infants with 130 established dislocations of the hip, 11% failed to respond to primary surgical treatment. Genetic and iatrogenic factors accounted for half the failures. There were no obvious causes in the remainder, though a few had the superficial stigmata of spinal dysraphism, and by two years of age, most of the group had developed a lateral rotation posture of the affected leg associated with a relatively smaller foot on that side. Radiologically, the femoral head had drifted and rotated laterally out of the surgically deepened acetabulum, causing persistent subluxation. Although there was no clinical evidence of sensory or motor denervation, sensory spinal evoked potential tests revealed the presence of neurological deficits in the majority of patients in this group.
Total hip replacement for adults with unreduced congenital dislocation presents a difficult problem because soft-tissue contractures usually prevent sitting at the normal anatomical level. Extensive soft-tissue division or a high-level acetabulum leads to reduced function and poor fixation of the components. We describe a new technique for hip replacement in such cases. The shortened abductors and flexors are released proximally and excision of the upper third of the ilium allows them to be repaired without tension, while providing bone graft to reconstruct the acetabular roof. We report 12 such replacements in 10 patients with good results and few early complications.
Rhodamine B is a red colored dye that is used in cosmetic products. We report a case of 17 patients who were exposed to aerosolized Rhodamine B inside a maintenance shop. The mean duration of exposure was 26 minutes (range 2-65). Sixteen of the patients (94%) complained of acute symptoms including: burning of the eyes (82%), excessive tearing (47%), nasal burning (41%), nasal itching (35%), chest pain/tightness (35%), rhinorhea (29%), cough (29%), dyspnea (29%), burning of the throat (24%), burning/pruritic skin (24%), chest burning (12%), headache (6%), and nausea (6%). All of the patients had resolution of their symptoms within 24 hours (less than 4 hours in 63%). Acute exposure to Rhodamine B resulted in transient mucous membrane and skin irritation without evidence of serious sequellae.
Nasotracheal intubation is a procedure used in the emergency department for airway management. Although the procedure has its attendant complications, we report the rare occurrence of an inferior turbinectomy. Other complications of the procedure are discussed.
In days gone by, trustees of nonprofit corporations were unlikely to be sued. Today, however, trustees are no longer immune from such actions. Prudent trustees must be able to assess their personal liability as interpreted within their twin fiduciary duties of care and loyalty, and take appropriate steps to minimize their risks.
Presented is the case of a 42-year-old, previously healthy man with meningitis secondary to Listeria monocytogenes. Following lumbar puncture, empiric therapy with intravenous penicillin was started and he was hospitalized. Subsequently L monocytogenes was proven to be the causative organism and antibiotic therapy was changed to ampicillin and gentamicin. The patient's condition improved. He was discharged and continues to do well. There was no evidence at any time of underlying predisposition to infection. Listeria meningitis in healthy patients and in patients with underlying disease is discussed, along with possible implications about choice of empiric antibiotics.
The in vitro initiation site for RNA polymerase I on the mouse rRNA gene was identified using a new method that is generally applicable to the study of other eukaryotic transcripts. First, the 5' end of mouse rRNA was located to an ApC . . . by high resolution S1 nuclease mapping. Dinucleotide primers were then used in transcription reactions to demonstrate that this position is the actual de novo initiation site, and not a rapid RNA processing site. For this analysis, initiation was inhibited by reduced rXTP concentration, and, upon supplementation with various dinucleotides, only ApC stimulated correct synthesis. Independently confirming its role as the initiating nucleotide, ATP was shown to be required at a much higher concentration than the other rXTPs for RNA initiation, but not for elongation. These results also demonstrate a marked sequence conservation of rRNA initiation sites between the mouse and frog, two species that violate the general rule of species specificity in RNA polymerase I initiation. Extending these studies to RNA polymerase III, the initiation site for 5 S RNA can be similarly located by dinucleotide analysis and confirmed from the concentration requirements of each rXTP. In addition to allowing initiation at suboptimal rXTP concentration, dinucleotide primers can also circumvent the need for a factor normally required for initiation, suggesting their potential value in dissecting the mechanism of eukaryotic transcription.
The DNA regions required for accurate initiation by RNA polymerase 1 on the ribosomal RNA genes of Xenopus laevis consist of at least two domains within a 150 bp segment adjoining the initiation site. A region of only 13 nucleotides (from -7 to +6) appears sufficient to specify accurate and efficient initiation when various 5' and 3' deletion mutants are injected into oocyte nuclei. In contrast, a 10-fold larger region (from -142 to +6) is required for maximal synthesis when deletion mutants are assayed in oocyte nuclear homogenates; only a low level of synthesis is specified by the 13 bp promoter domain in this in vitro system. Site-specific mutants demonstrate that a sequence adjoining nucleotide -75 is also essential for efficient in vitro initiation. Under other conditions, transcription can be strongly affected by sequences that extend several kb upstream in the rDNA spacer and contain duplications of sequences found within the 150 bp promoter. We propose a model in which transcription of the X. laevis rRNA genes is regulated by interaction of at least three sequence domains that extend over a several kb region.
A study of 178 cases of congenital dislocation of the hip in babies born between 1965 and 1978 in Southampton health district showed that the incidence had virtually doubled over this period. Established cases (persisting beyond the first birthday) had risen to around two cases per 1000 per live births. One-third of these were first diagnosed after the age of 1 year and one-fifth after 18 months. The findings are particularly disappointing as there were opportunities after the neonatal period for earlier diagnosis. Thus, neonatal screening appears to have failed to make a substantial impact on the morbidity of the disease, probably because of a combination of inherent difficulties in the neonatal screening test as well as failure in its proper application. Much greater vigilance is needed during the first year of life if congenital dislocation of the hip is to be detected and treated as early as possible. Perhaps this could be achieved if all health professionals were more aware of the problem and were encouraged to examine hips at every opportunity and health authorities periodically audited their results.
The effect of long-term ethanol supplementation on folate metabolism was studied in McCollum rats receiving approximately 30% of their caloric intake as ethanol. Ethanol did not significantly affect hepatic or plasma total folate levels. The net hepatic uptake and metabolism of a labeled folate dose to polyglutamate forms were unimpaired by ethanol administration. In fact, the ethanol-fed animals metabolized hepatic pteroylmonoglutamates to polyglutamate forms, predominantly the pentaglutamate, at a slightly faster rate than the control animals, and the net hepatic uptake of the labeled dose was higher than in the controls. Tetrahydrofolate derivatives were the predominant one-carbon form of folate in the livers of ethanol-fed and control animals, although the proportion of folate in the 5-methyltetrahydrofolate form was slightly increased after ethanol supplementation. Although hepatic metabolism of folate appears to be unimpaired in the ethanol-fed rat, an increased rate of pteroylpolyglutamate synthesis, with a resulting increase in the tissue storage of folate, might be a contributing factor to the low serum folate levels reported in alcoholics.